Pulmonary Embolism Flashcards
Pass the exam :)
What are the advantages of LMWH over unfractured heparin?
greater bioavailability, subQ administration, longer duration of therapeutic effect, and no need to monitor the aPTT
What is pulmonary embolism (PE)?
Collection of solids, liquids or air that enter the venous circulation and lodges in pulmonary arteries.
What are the nursing interventions done for PE?
- Notify the rapid response team
- Elevate head of bed and reassure patient
- Administer oxygen as needed
- Put the patient on Telemetry and continuous pulse oximetry
- Perform respiratory and cardiac assessments, assess skin for petechiae
- Ensure IV access
- Prepare patient for lab diagnostics and prepare for an ABG
- Prepare patient for anticoagulants and/or thrombolytics
- Adequate fluid volume replacement to support blood pressure
- Continuous EKG monitoring
- Pulmonary artery/central venous pressure monitoring
- Monitor urine output
- Skin turgor/mucous membranes
- Bleeding precautions
What is the most common cause of PE?
Deep vein thrombosis (DVT) or venous thromboembolism (VTE)
What are relative contraindications or cautions for use of tPA?
- Severe, uncontrolled HTN (BP> 180/110 mm Hg)
- Hx of chronic, severe, poorly controlled HTN
- Hx of prior ischemic stroke, dementia, or known intracerebral pathology not covered in absolute contraindications
- Current use of anticoagulants in therapeutic doses (INR 2–3 or greater); known bleeding diathesis
- Traumatic or prolonged CPR (more than 10 min) or major surgery (less than 3 wk ago)
- Recent internal bleeding (within 2–4 wk)
- Noncompressible vascular punctures
- Pregnancy
- Active peptic ulcer
What are the different diagnostic tests done for PE?
- D-dimer (usually positive for large clots, small clots may be normal)
- ABG (intially resp alk due to hyperventilation, then resp acidosis due to increase CO2, then metab alkalosis due to increase in lactic acid that needs to be compensated)
- Chest X-ray (usually shows large PE)
- CT pulmonary angiography (CTPA) – gold standard
- Transesophageal Echocardiography (TEE) (to find the location of clot)
- Doppler Ultrasound (done on lower extremities to rule out DVTs)
- VQ scan (chronic COPD, pulmonary fibrosis, pneumonia, pleural effusion already have VQ mismatch so can affect the study)
What is the most common symptom of PE?
Dyspnea (occurs in 85% of PE patients)
Pulmonary hypertension is usually caused from?
recurrent pulmonary emboli
DVT prophylaxis includes the use of ____ _____ devices, early _____, and ____ medications.
sequential compression devices, early ambulation, and anticoagulant medications
Fat emboli is usually caused from ?
fracture of long bones such as femur
What are the clinical manifestations of PE?
Dyspnea (difficulty breathing), tachycardia, tachypnea, sudden stabbing chest pain, normal breath sounds or crackles, decreasing pulse oximetry, hemoptysis, JVD, syncope, cyanosis, low PaCO2 at first then raising, hypotension, S3 or S4 heart sounds, sudden change in mental status, feeling of impending doom (also present in blood transfusions, anaphylaxis), anxious, apprehension or restlessness, petechiae over chest, and signs and symptoms of DVT.
PE takes years to develop in patients. True or False.
False. PE can occur suddenly.
What diagnostic test for PE is done on patients who cannot receive contrast media?
VQ scan
What are the major complications of PE?
pulmonary infarction (alveolar necrosis and hemorrhage) and pulmonary hypertension
What are absolute contraindications for tPA?
- Prior intracranial hemorrhage,
- known structural cerebral vascular lesion,
- ischemic stroke within last 3 months except ischemic stroke within 4.5 hr,
- known intracranial neoplasm,
- active internal bleeding (other than menses),
- suspected aortic dissection
What is saddle embolus?
a large thrombus lodged at an arterial bifurcation
What are some of the causes of PE?
DVT or VTE, chemotherapy, women treated with Tamoxifen for breast cancer, tumors, obesity, hormone therapy, oral contraceptives, cigarette smoking, pregnancy, prolonged immobility, clotting disorders, heart failure (poor pump), atrial fibrilation, central venous catheters, advancing age, sepsis, fat emboli, air emboli, bacterial vegetation on heart valves
The signs and symptoms of PE can be varied and nonspecific, and depend on size and extent of emboli. True or False.
True
When is anticoagulant therapy contraindicated for PE?
blood dyscrasias, hepatic dysfunction, overt bleeding, a history of hemorrhagic stroke, or HIT
What respiratory measures are important to prevent or treat atelectasis?
turning, coughing, deep breathing, and incentive spirometry
What are the drug therapy for PE?
- Heparin, Enoxaparin, Warfarin (anticoagulants)
- Fibrinolytics (thrombolytics) (tPA)
- Diuretics (for heart failure patients)
- Pain management (opiods)
- Vasopressors (to increase perfusion)
- Positive inotropic agents (to increase contraction of heart)
- Dobutamine
- Milrinone (to increases cardiac output)
- Nitroprusside (to reduce pulmonary artery pressure)
Surgery to which part of the body poses high risk for PE?
pelvic and lower extremity
Pain resulting from pleural irritation or reduced coronary blood flow is treated with NSAIDS. True or False.
False. It is treated with opioids.
PE patients need to be on anticoagulant therapy continues for at least ___ months and those with recurrent PE need to be for _____
3 months, indefinitely
